Kieran O'Donnell (Limerick City, Fine Gael) | Oireachtas source

I am glad to have the opportunity to speak on this very important Bill, which has been the subject of wide-ranging discussion and deeply, genuinely held views. I think everyone would agree that providing a safe medical environment for both mother and child is vital. We must ensure the integrity and transparency of the legislation and, as stated by the Minister, Deputy Reilly, in his Dáil speech on 20 June, ensure it upholds the constitutional right to life of the unborn.

In the time I have available to me, I wish to approach the Bill on a constructive basis, to look at ensuring its robustness, and where necessary, to enhance and strengthen the framework of the legislation. I thank the Minister for Health, Deputy Reilly, for engaging with me and others in discussions on the Bill. The work of the Minister and his ministerial colleagues, including the Minister of State, Deputy White, who is present in the Chamber, needs to be acknowledged.

I wish to direct my attention today to the broad areas of reporting and good governance in the Bill, the constitutionality of the Bill and other aspects.

The principal reporting and governance sections are section 4, which deals with regulations; section 11, which deals with establishment of review panels; section 15, report by the HSE to the Minister on the operation of the review process; and section 20, dealing with notifications to the Minister of medical procedures carried out under sections 7, 8 and 9, which deal with risk of loss of life of a pregnant woman.

Having studied the legislation in detail, I believe there are areas where the reporting and governance could be enhanced in order to strengthen it. On section 4, which deals with regulations, the Minister for Health stated that he had begun a consultation process with the relevant professional medical bodies to develop clinical guidelines on the implementation of this legislation and the establishment of a multidisciplinary committee to develop these guidelines. I believe this to be a very important aspect of the legislation, in particular section 9, which deals with risk of loss of life from suicide. While I welcome the Minister's initiative, I would like to make two points that I believe would enhance the robustness of the process.

First, nominations to the multidisciplinary committee should be sought from the four relevant medical professional bodies outlined in section 11(3), which relates to the review panel, namely, the Institute of Obstetricians and Gynaecologists, the College of Psychiatrists of Ireland, the Royal College of Surgeons in Ireland and the Royal College of Physicians of Ireland, as well from as the Medical Council and the Irish College of General Practitioners. The medical professions' direct involvement in developing these guidelines is relevant as they have the first-hand knowledge of best clinical practice and research and will be responsible for its implementation. Second, it would make perfect sense for the Bill not to come into operation until the regulations have issued. That is good practise.

On section 11, establishment of the review panel, etc., I welcome, as stated under section 11(3), that the HSE is to request four professional medical bodies to nominate medical practitioners for appointment to the review panel. However, subject to these people meeting the necessary qualifications, their nominations to the review panel should be accepted. This is important for the integrity of the legislation, as they contribute best up-to-date clinical knowledge, practice and research to the process.

I would welcome the same reporting requirements under section 15, reviews, and, section 20, notifications. On the basis of consistency and good governance, the reporting requirements under section 20 should be the same as under section 15. This does not appear to be the case under the Bill as currently drafted. Under section 15(2), an annual report to the Minister provides details of (a) the total number of applications for review received by the HSE; (b) the number of reviews carried out and the reason these reviews were sought; and (c) the outcome of the reviews, while at all times providing absolute confidentiality to the woman involved, which is extremely important. While these measures are to be welcomed, there does not appear to be similar provisions under section 20 for reporting the total number of applications received and refusals under sections 7 and 9. I believe this information should be provided to ensure the Minister has information consistent with that he receives under section 15(2) in respect of reviews.

On the reporting requirements to the Minister under section 20 - notifications, under section 20(3) as currently framed - it would appear the only information currently provided to the Minister in respect of sections 7 and 9, physical illness and the risk of loss of life by suicide, respectively, is the Medical Council registration number for the medical practitioner who carried out the medical procedure under these sections. Specifically, under this subsection, to enhance the governance of the legislation and to ensure the Minister has full information, he or she should be also provided with the Medical Council registration numbers for medical practitioners who carried out the certifications under sections 7 to 9, inclusive, and 13. By ensuring that only the registration numbers of the medical practitioners are provided, the privacy of medical practitioners is maintained. This approach is similar to that under section 20(3) for the medical practitioner who carried out the medical procedure. Furthermore, to provide further assurance on the confidentiality of the medical practitioners involved, under sections 20(4) and 20(5), which are the reports prepared by the Minister, it is up to the Minister to prepare and publish the report in such form and manner as he or she thinks appropriate. The Minister has enormous discretion in this area.

On publication of reports under section 15, reviews, and section 20, notifications, under section 20(4) and 20(5), the Minister prepares and publishes a report in such form and manner as he or she thinks appropriate. For consistency, this publication procedure should also apply under section 15, reviews, and both reports should be laid before each House of the Oireachtas at the time of publication. This reporting process would enhance the integrity of the legislation, while giving the Minister the flexibility to ensure confidentiality is afforded to the woman and medical practitioners involved. It is important this is taken on board to ensure the integrity of the process.

On certification under section 19, section 19(b) of the Bill as drafted relates to the prescribed information to be included in the certificate and may need to be strengthened to ensure the clinical grounds for carrying out the medical procedures are specified. From my reading of the Bill, this may not be the case. For the integrity and transparency of the legislation, it makes sense to ensure this happens.

On the constitutionality of the Bill and other aspects, the Minister made reference to the reasonable opinion definition and specifically stated that the medical practitioner will be obliged to make every effort to safeguard the unborn and where it is potentially viable outside the womb to make all efforts to sustain its life. In the interest of clarity, should this point not be explicitly stated in the Bill as part of the definition of reasonable opinion? Furthermore, should the reference to a medical opinion given in good faith - good faith is mentioned throughout the legislation - not also refer to due regard being given to best clinical practice and research, as set out in current medical guidelines in this area?

Since the publication of this Bill, the former Director of Public Prosecutions, DPP, Mr. Eamonn Barnes, has expressed the view that without representation for the unborn under section 9, which deals with risk of loss of life due to suicide, or sections 13 and 14, which deal with reviews, the Bill may be unconstitutional. The constitutionality of all aspects of the legislation needs to be looked at as it may possibly end up before the Supreme Court.

Having studied the legislation in great detail, I raise these points in a constructive manner with the express intention of ensuring the integrity, transparency and effectiveness of the Bill. As legislators, we must test the robustness of the framework underpinning the legislation and ensure it stands up constitutionally because, as I stated, it may end up before the Supreme Court. There is little point in going through the legislative process if we do not do everything possible to achieve this end.

This is a difficult debate for everyone involved. I have proposed reasonable changes which would provide clarity, consistency and transparency in several areas. Above all, they would provide for a safe medical environment for the mother and child, while upholding the rights of the unborn, as provided for in the Constitution.

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